Non-adherence to ivabradine and placebo and outcomes in chronic heart failure: an analysis from SHIFT

Böhm, M. et al. (2016) Non-adherence to ivabradine and placebo and outcomes in chronic heart failure: an analysis from SHIFT. European Journal of Heart Failure, 18(6), pp. 672-683. (doi: 10.1002/ejhf.493) (PMID:26952245)

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Aims In heart failure, non-adherence increases events; in turn, the effect of hospitalization on adherence is incompletely understood. We explored the relationship of non-adherence to outcomes, hospitalizations with non-adherence, and the influence of non-adherence on treatment effects of heart rate lowering with ivabradine. Methods and results In the randomized, controlled Systolic Heart failure treatment with the If-inhibitor ivabradine Trial (SHIFT), we studied the effect of non-adherence (n = 1287) compared with adherence (n = 5204) on cardiovascular outcomes. After adjustment, non-adherence was associated with the primary composite endpoint of cardiovascular death and heart failure hospitalization (hazard ratio 3.47, 95% confidence interval 2.91–4.13, P < 0.0001). No interaction with the treatment groups of placebo or ivabradine (P for interaction 0.54) occurred. Similar results for cardiovascular death and heart failure hospitalization, as well as for cardiovascular hospitalization, heart failure death, and total death were observed. The effect of ivabradine was maintained in patients being adherent or becoming non-adherent during the trial (P for interaction = 0.54). Patients with a previous hospitalization were more likely to become non-adherent thereafter. Conclusions Non-adherence identifies a group at particularly high cardiovascular event risk independent of treatment allocation. Non-adherent patients in the ivabradine group maintain a treatment benefit. Patients with previous hospitalizations are more likely to become non-adherent and represent a group of particularly high-risk patients in whom special attention to stimulate adherence may be valuable.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Ford, Professor Ian and Lloyd, Miss Suzanne
Authors: Böhm, M., Lloyd, S., Ford, I., Borer, J. S., Ewen, S., Laufs, U., Mahfoud, F., Lopez-Sendon, J., Ponikowski, P., Tavazzi, L., Swedberg, K., and Komajda, M.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:European Journal of Heart Failure
Publisher:John Wiley and Sons, Inc.
ISSN (Online):1879-0844
Published Online:08 March 2016
Copyright Holders:Copyright © 2016 The Authors and the European Society of Cardiology
First Published:First published in European Journal of Heart Failure 18(6): 672-683
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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